Provider Demographics
NPI:1821005943
Name:MERCADANTE, NICHOLAS MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:MICHAEL
Last Name:MERCADANTE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:100 HOSPITAL RD
Mailing Address - Street 2:SUITE 3B, PROFESSIONAL BUILDING
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-2253
Mailing Address - Country:US
Mailing Address - Phone:978-534-3179
Mailing Address - Fax:978-840-3160
Practice Address - Street 1:100 HOSPITAL RD
Practice Address - Street 2:SUITE 3B, PROFESSIONAL BUILDING
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-2253
Practice Address - Country:US
Practice Address - Phone:978-534-3179
Practice Address - Fax:978-840-3161
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2010-09-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA48638207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6191193Medicaid
MAA66344Medicare UPIN
MAJ04427Medicare ID - Type Unspecified